ESPU Meeting on Thursday 4, September 2025, 08:00 - 08:50
08:00 - 08:03
S09-1 (OP)
Efe Semetey OGUZ 1, Mustafa Alkan OKTAR 2, Mehmet Fatih OZKAYA 3, Berk BURGU 4, Omer Suat FITOZ 5 and Yakup Tarkan SOYGUR 4
1) TRABZON AKÇAABAT HAÇKALI BABA STATE HOSPITAL, Urology, Trabzon, TÜRKIYE - 2) Ankara Pursaklar State Hospital, Urology, Ankara, TÜRKIYE - 3) ANKARA UNIVERSITY, Urology, Ankara, TÜRKIYE - 4) ANKARA UNIVERSITY, Pediatric Urology, Ankara, TÜRKIYE - 5) ANKARA UNIVERSITY, Pediatric Radiology, Ankara, TÜRKIYE
PURPOSE
Routine voiding cystourethrography (VCUG) is commonly performed to exclude vesico-ureteral reflux (VUR) in patients with antenatally diagnosed unilateral hydroureteronephrosis (HUN). This study evaluates whether differences in kidney lengths, as determined by postnatal ultrasound (US), can reduce the need for routine VCUG in this group.
MATERIAL AND METHODS
We retrospectively analyzed the VCUG and urinary ultrasonography (US) data of patients diagnosed with unilateral antenatal hydronephrosis (HN) between 2009 and 2023, within the 0-1 age range. Patients whose postnatal ultrasound detected hydroureteronephrosis at our center were included in the study. Those with complex urinary system anomalies were excluded. Kidney dimensions, parenchymal thickness, renal pelvis diameters, Society for Fetal Urology (SFU) grades, and distal ureter diameters were analyzed. The longitudinal length difference between affected and healthy kidneys was calculated as a percentage: [(Affectedkidney−Healthykidney)/Healthykidney×100].
RESULTS
Among all reviewed cases, 119 patients met the inclusion criteria, and reflux grades 3-5 were observed in 41 cases (34.5%). Using a cut-off of "-8.2%" for the affected kidney length ratio, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 70.73%, 91.03%, 80.56%, and 85.54%, respectively. Patients with ratios below "-8.2%" had higher reflux risk (OR 17.23, CI 5.84-50.83, p<0.001). Reduced parenchymal thickness further increased reflux risk (OR 5.07, CI 1.31-19.64, p=0.019).
CONCLUSIONS
Smaller kidney size and parenchymal thinning on US strongly correlate with VUR risk. Additionally, when the percentage difference in kidney sizes was above the determined threshold, the likelihood of high-grade reflux was significantly reduced. This study highlights the potential to develop new diagnostic algorithms based on non-invasive, low-cost, and contrast-free US examinations. Such approaches could minimize the need for the invasive VCUG procedure, which carries associated risks and complications.
08:03 - 08:06
S09-2 (OP)
Yichen HUANG, Yiqing LYU, Fang CHEN, Yu DING, Zhiwei PENG and Ming WU
Shanghai Children's Hospital, Urology, Shanghai, CHINA
PURPOSE
This study evaluated the effectiveness of circumcision and continuous antibiotic prophylaxis (CAP) in preventing febrile urinary tract infection (fUTI) in boys with high-grade primary vesicoureteral reflux (VUR).
MATERIAL AND METHODS
This retrospective review was conducted using clinical data from 114 boys diagnosed with grades III–V primary VUR at Shanghai Children’s Hospital from June 2019 to 2022. The mean age of the enrolled children was 28.03 months. Participants were assigned to one of the following groups: observation (n = 14), CAP (n = 23), circumcision (n = 38), and CAP + circumcision (n = 39). The follow-up duration was 2 years. The incidence of febrile UTIs in each group was documented, and the efficacy of conservative management strategies was evaluated.
RESULTS
Among the 114 children, 15 (13.2%) experienced recurrent febrile UTIs. Recurrences were observed in 6 (42.9%), 7 (30.4%), 2 (5.3%), and 0 (0%) in the children in the observation, CAP, circumcision, and CAP + circumcision groups, respectively (P< 0.001). Significantly lower recurrence rates were observed in the circumcision and CAP + circumcision groups than in the CAP and observation groups. Further analysis determined circumcision as a significant factor in reducing febrile UTI recurrence (P< 0.001).
CONCLUSIONS
Circumcision plays a crucial role in reducing fUTI recurrence in boys with primary high-grade VUR. Interestingly, combining circumcision with CAP provides the highest level of protection against fUTI recurrence.
08:06 - 08:09
S09-3 (OP)
Ömer Bariş YÜCEL, Sumeyye SÖZDUYAR, Yusuf Atakan BALTRAK, Si̇bel TİRYAKİ, Ali̇ TEKİN and İbrahi̇m ULMAN
Ege University, Department of Pediatric Surgery, Division of Pediatric Urology, İzmir, TÜRKIYE
PURPOSE
Endoscopic treatment (ET) for vesicoureteral reflux (VUR) is a widely accepted procedure with a success rate between 70% to 90%. Despite various studies, a reliable predictive model for ET outcomes is still lacking. Being born small for gestational age (SGA), defined as a birth weight falling below the 10th percentile, has been linked to congenital urological disorders and potential developmental disparities. We noticed that a significant portion of the failed cases consisted of patients who born SGA. Based on this observation, we sought to evaluate correlation between SGA and ET failure.
MATERIAL AND METHODS
Clinical data from children who underwent ET for VUR between 2013 and 2023 were analyzed. Factors considered included gestational age (GA), birth weight, associated anomalies, VUR grades, renal function, scarring, and operative variables, as well as post-treatment VCUGs. Secondary and complex VUR cases were excluded. Children were categorized into SGA and non-SGA groups for comparative analysis.
RESULTS
Sixty-five children (40 girls, 25 boys) representing 104 renal units were included. The average age at ET was 4.2 years. No significant differences were found between the SGA (n=10) and non-SGA (n=55) groups in terms of GA, VUR grade, renal scarring, and age at operation. However, the SGA group had a significantly lower success rate in VUR resolution compared to the non-SGA group (20% and 82%, respectively; p<0.001). Multivariate logistic regression indicated SGA as an independent risk factor for ET failure with an odds ratio of 13.3.
CONCLUSIONS
This study is pioneering in examining the relationship between SGA and ET failure. The results suggest that SGA is a significant independent risk factor and have the potential to lead to changes in surgical strategies and patient counseling after further validation studies.
08:21 - 08:24
S09-4 (OP)
Kazuyoshi JOHNIN 1, Jun MATSUBAYASHI 2, Kenichi KOBAYASHI 1, Tetsuya YOSHIDA 1, Susumu KAGEYAMA 1 and Akihiro KAWAUCHI 3
1) Shiga University of Medical Science, Urology, Otsu, JAPAN - 2) Shiga University of Medical Science, Center for Clinical Research and Advanced Medicine, Otsu, JAPAN - 3) Otsu City Hospital, Urology, Otsu, JAPAN
PURPOSE
The gold standard for treating primary vesicoureteral reflux (VUR) is open ureterocystoneostomy (UCN). Transvesical ureteral reimplantation (TVUR) is one of the laparoscopic surgeries covered by national insurance in Japan. We investigated the feasibility and outcomes of TVUR for patients on VUR
MATERIAL AND METHODS
From April 2012 to March 2022, we conducted a retrospective multicenter survey of patients on VUR who underwent TVUR and UCN in Japan. We collected 1,360 patients (514 in the group of TVUR and 846 in the UCN) from 25 institutions by the Japanese Society of Endourology and Robotics and 7 institutions by the Japanese Society of Pediatric Urology. To compare TVUR and UCN, in terms of perioperative outcomes, hospital stay, and reoperation rate.
RESULTS
After 1:1 propensity score matching, were 450 patients in each group (the TVUR group and the UCN group). Surgery time was significantly longer in the TVUR group [263 (220, 322), 184 (151, 229) minutes]( P<0.001). Urinary catheter removal was earlier in the TVUR group [3 (2, 5), 5 (3, 7) days](<0.001). Postoperative hospital stay was significantly shorter in the TVUR group [5 (4, 7) vs. 7 (5, 8) days]. In the comparison of reoperation rate rates, the TVUR group demonstrated higher than the UCN group (HR 4.16 [1.18, 14.59](P=0.026). Among patients under 10 years old, the risk of reoperation was higher in the TVUR group.
CONCLUSIONS
After propensity score-matched analysis the TVUR group demonstrated longer surgery time and higher re-operation rates with shorter hospital stays.
08:24 - 08:27
S09-5 (OP)
Berk HAZIR 1, Mujdat AYVA 1, Merve KASIKCI 2, Tuna CAK 3, Serdar TEKGUL 1 and Hasan Serkan DOĞAN 1
1) Hacettepe University Faculty of Medicine, Urology, Ankara, TÜRKIYE - 2) Hacettepe University Faculty of Medicine, Biostatistics, Ankara, TÜRKIYE - 3) Hacettepe University Faculty of Medicine, Child and Adolescent Psychiatry, Ankara, TÜRKIYE
PURPOSE
In pediatric urology, the interest taken in major surgeries is often much less than that of minor surgeries, since their physical and psychological impacts are considered severe. However, studies that investigate long-term QoL, including homogeneously distributed patients according to diagnosis, still need to be conducted. We aimed to compare endoscopic subureteric injection with conventional open ureteral reimplantation in vesicoureteral reflux disease (VUR) in terms of long-term postoperative QoL to find potential factors that would predict the outcome.
MATERIAL AND METHODS
This retrospective cohort was based on data from February 2016-December 2019 on 115 children and adolescents (4 - 18 years old) who underwent elective surgery due to VUR disease and were hospitalized thereafter. Patients were divided into two groups according to surgery they underwent: "Endoscopic subureteral Hyaluronic Acid/Dextranomer copolymer injection" (n = 65) and "Open Ureteroneocystostomy" (n = 50). With their mothers, the patients filled out the Pediatric Quality of Life Questionnaire (PedsQL) remotely 2 to 6 years post-surgery (median 49 months) and were compared between each other with the regards of postoperative quality of life. Those with congenital or concomitant diseases were excluded.
RESULTS
Patients undergoing different surgery types had similar scores in all domains in PedsQL. Linear regression analysis also showed that surgery type, length of hospital stays, previous surgery experience, and patients' age at the time of the survey was not associated with postoperative long-term QoL. However, the only predictor for higher postoperative QoL was the maternal higher education level (Est: 10.89; 95% CI: 1.54 - 20.23; p= 0.023).
CONCLUSIONS
Our study showed that minimally invasive nature of endoscopic treatment did not provide a significant advantage over open reimplantation in terms of long term postoperative QoL.
08:27 - 08:30
S09-6 (OP)
Heather ROTZ 1, Andrew MCCLURE 2, Melody LAM 3, Britney LE 3, Blayne WELK 1, Sumit DAVE 1 and Zhan Tao WANG 1
1) Western University, Surgery, London, CANADA - 2) Institute for Clinical Evaluate Sciences, Surgery, London, CANADA - 3) Institute for Clinical Evaluate Sciences, Data Science, London, CANADA
PURPOSE
Follow-up protocols after vesicoureteral reflux (VUR) surgery vary widely, with no consensus on duration or type of surveillance (Herndon et al., J Urol 2001; 165: 559-563). This study aims to define the postoperative period capturing at least 99% of complications requiring reoperation and to identify predictors for extended follow-up needs.
MATERIAL AND METHODS
This retrospective, population-based cohort study included pediatric patients who underwent open or endoscopic VUR surgery between 2002 and 2018. Patients were identified using procedural/billing codes and followed for 5-years. The primary outcome was reoperation related to VUR surgery. A composite outcome representing early complications was also captured. Time from VUR surgery to reoperation was explored and multivariable regression was performed to assess patient- and procedure-related predictors of reoperation more than 2-years after the initial surgery.
RESULTS
The study included 787 patients (open: 332; endoscopic: 455), with a mean age of 3.92 years (SD ± 2.95). Early complications occurred in 25.4%, including unplanned emergency visits (14.1%) and hospital readmissions (3.4%), whereas 15.2% of patients underwent a reoperation. The median time to reoperation was 313 days (IQR: 140–661) and 3.2% underwent a reoperation after >2 years of follow-up. Early complications and younger patient age significantly predicted later interventions beyond two years (Table 1).
| Table 1. Results from regression analysis predicting reoperarion after >2 years | |||
| Covariate | OR | 95% CI | p-value |
| Patient age | 0.826 | 0.689 - 0.99 | 0.0387 |
| Surgical approach (open vs endoscopic) | 0.989 | 0.392 - 2.499 | 0.9818 |
| System complexity (complex vs normal) | 1.053 | 0.339 - 3.269 | 0.9292 |
| Early complication (yes vs no) | 3.849 | 1.662 - 8.913 | 0.0017 |
CONCLUSIONS
Most postoperative complications and secondary interventions occur within the first 2 years, though a subset remains at risk beyond this period. Individualized follow-up protocols based on patient- and procedure-specific risk factors could improve care while reducing unnecessary healthcare costs.
08:30 - 08:33
S09-7 (OP)
Dacia DI RENZO 1, Valentina CASCINI 1, Lorenza SACRINI 2, Maria Enrica MISCIA 3, Gabriele LISI 3 and Giuseppe LAURITI 3
1) "Santo Spirito" Hospital of Pescara, Pediatric Surgery Unit, Pescara, ITALY - 2) "G. d'Annunzio" University of Chieti-Pescara, Pediatric Surgery Unit, Chieti-Pescara, ITALY - 3) "G. d'Annunzio" University of Chieti-Pescara and "Santo Spirito" Hospital of Pescara, Department of Medicine and Aging Sciences - Pediatric Surgery Unit, Chieti, ITALY
PURPOSE
Postoperative ureterovesical junction obstructions (UVJOs) may occur following endoscopic treatment for vesicoureteral reflux (VUR). Aim of the present study were to analyze whether there is a role for endoscopic balloon dilatation to manage these secondary UVJOs.
MATERIAL AND METHODS
A single-center retrospective study was performed in those patients endoscopically treated for VUR in a defined time-period (from 2014 to 2024). Children with UVJOs caused by endoscopic injections were then selected and those cases managed with endoscopic balloon dilatation were finally included in the present study. Primary endpoint was the incidence of resolution of the obstruction. Data are expressed as median (range) and were analyzed with t test. A p value < 0.5 was considered significant.
RESULTS
In a 11-year period, 121 patients (175 renal unit) were endoscopically treated for VUR. At follow up, 8 UVJOs (7 patients) occurred after 21.5 months (2 - 63 months) since the last endoscopic injection. Four/8 obstructed ureter (3 patients) were managed by endoscopic balloon followed by double-J ureteral stenting. At presentation, pre-vesical ureteral dilation at ultrasound study (US) was 11 mm (7 - 16 mm), antero-posterior diameter (APD) of renal pelvis was 35 mm (30 - 75 mm). All postoperative periods were uneventful. Ureteral stents were removed after 57.5 days (40 - 65 days). At a follow of 8.3 months (3 - 18.5 months), pre-vesical ureteral dilation at US was 9 mm (6 - 16 mm), APD of renal pelvis was 32.5 mm (25 - 60 mm), with no significant improvement from the data at presentation (p = ns). Two patients were subsequently treated by ureteral reimplantation.
CONCLUSIONS
Hence a preliminary, single-center experience in a small number of patients, endoscopic ballooning seems not to be effective in managing UVJOs caused by endoscopic treatment of VUR. However, further studies would be required to corroborate these outcomes.